• Ian F Dunn, Dong H Kim, Peter A Rubin, Russell Blinder, Jonathan Gates, and Alexandra J Golby.
• Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
• Neurosurgery. 2009 Aug 1; 65 (2): E383-4; discussion E384.

ObjectiveIntraorbital wooden foreign bodies--usually from a low-velocity puncture--are elusive and demand a low threshold for further imaging. In patients with traumatic injuries, orbital and intracranial air from fractures may be present, and it is particularly easy to overlook a wooden fragmentClinical PresentationA 53-year-old equestrian was kicked in the face by the rear hoof of a horse. The event was captured on video by her husband. Although no obvious entry point in and around the eye was observed, her ocular examination was notable for superior orbital fissure syndrome and increasing intraocular pressure in the left eye. Closer inspection revealed a 5-mm laceration above her superior lid margin; imaging revealed a foreign body at the orbital apex with apparent communication with the cranial vault.InterventionWe proceeded with cranio-orbital exploration because of the risk of continued ocular damage in the setting of increasing intraocular pressure and the potential for infection of both the eye and the intracranial space from a suspected foreign body. A 3.0 cm x 0.5 cm fragment was found lodged in the orbital apex and removed.ConclusionThe patient recovered well after surgery and a course of antibiotics and has returned to riding. This case report presents an algorithm for approaching cranio-orbital foreign objects of unclear identity and the favorable outcomes that may be achieved.

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